Background: In the clinical examination of patients with low back pain (LBP), musculoskeletal physiotherapists routinely assess lumbar spinal segmental motion by performing physical examination procedures such as observation of active range of motion and palpation of intervertebral motion. The validity of manual assessment of segmental motion, however, has not been adequately investigated. Methods: In this pragmatic, multi-centre, criterion-related validity study, 138 consecutive patients with LBP were recruited and examined by physiotherapists with postgraduate training in musculoskeletal manual therapy. Clinicians examined each patient�s spine for the presence of segmental motion abnormalities, described as lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI), then referred the patients for flexion-extension (FE) radiographs. The physical examination procedures of interest were: 1) assessment of forward-bending (FB) active range of motion (AROM); 2) FB and backward-bending (BB) passive physiological intervertebral motion testing (PPIVMs) in the sagittal plane; and 3) central postero-anterior passive accessory intervertebral motion testing (PAIVMs). Sagittal displacement kinematics of the lumbar spinal segments were measured from the FE radiographs, and served as the criterion standard against which the clinical assessment results were compared. The kinematic parameters measured were sagittal rotation, sagittal translation, ratio of translation per degree of rotation (TRR), instantaneous axis of rotation (IAR), and centre of reaction (CR). Reference ranges for normal motion were calculated from the analysis of FE radiographs of 30 asymptomatic volunteers. The accuracy and validity of the clinical examination procedures were then calculated, and reported as sensitivity, specificity, and likelihood ratios for a positive test (LR+) and a negative test (LR-). Results: In patients with LBP, sagittal rotation LSR and sagittal translation LSR had a prevalence of approximately 5.7% (p <0.0005) in this cohort. Sagittal rotation LSI was not found in statistically significant numbers. Sagittal translation LSI was found at a prevalence of 3.6% (p <0.05). Abnormal TRR (23.3%), IAR (17.7%), and CR (16.5%) were more prevalent findings (all p <0.0005). Observation of the quantity of AROM, during FB, is not valid for the assessment of either total lumbar segmental sagittal rotation, or detection of individual segments with abnormal segmental motion. PPIVMs and PAIVMs are specific, but not sensitive, for the detection of rotation LSI and translation LSI. A positive test (grade 4 on a scale from 0 to 4) with BB PPIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 8.4 and 7.1 respectively (and 95% CIs from around 1.7 to 38). Likelihood ratio statistics for FB PPIVMs were not statistically significant. A positive test (grade 2 on a scale from 0 to 2) with PAIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 2.7 and 2.5 respectively (and 95% CIs from around 1.01 to 7.5). Neither PPIVMs nor PAIVMs were useful for the detection of LSR, or abnormal quality of motion as measured by TRR, CR, and IAR. Conclusions: Abnormal spinal segmental motion is associated with the symptom of LBP, in patients presenting to physiotherapists with a new episode of recurrent or chronic LBP, however prevalence is low due to highly variable lumbar segmental motion among asymptomatic individuals. Manual physical examination has moderate validity, but limited utility on its own, for the detection of translation LSI. Further research should investigate the utility of other clinical examination findings for the detection of lumbar segmental mobility disorders.

The purpose of this study was to evaluate the methods currently available to measure the functional outcomes of physiotherapy treatment for low back problems. As a preliminary step, all extant questionnaires were located and evaluated against practical criteria to determine their likely utility in clinical practice. This process identified a large number of questionnaires, however, only six back-specific questionnaires fulfilled the practical criteria for clinical application. Four of these questionnaires were selected for further evaluation along with a generic health status assessment instrument, the SF-36 Health Survey. Current recommendations suggest that a low-back specific and a generic questionnaire are required for comprehensive assessment of the impact of low back problems. The four back-specific questionnaires selected were the Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Waddell Disability Index. An evaluation of the literature on the clinimetric properties of these questionnaires revealed that little information was available for the Quebec and Waddell questionnaires and no information was available for any of the questionnaires for a clinical population of people with low back pain seeking physiotherapy treatment in an Australian setting. The primary aim of the research was identify which, if any, of the questionnaires should be recommended for measuring outcomes of physiotherapy treatment for low back pain. Consecutive ambulatory (non-admitted) patients presenting for physiotherapy treatment at three public hospital physiotherapy outpatient departments, three community health services, and four private practices were invited to enter the study. Patients were included if they were seeking treatment for a low back problem, were aged 18 or over, and could read and write English. Subjects completed the questionnaires on two occasions six-weeks apart. One hundred and forty subjects returned the first set of questionnaires, and 106 the second set. The mean age of the sample at pre-test was 51 (SD 17) and ranged from 18 to 89 years. Sixty-six percent were female, 41% were employed and 12% were receiving compensation for their back problem. Duration of the back complaint was more than six weeks for 56% of subjects, and 60% reported five or more previous episodes or continuous pain. Referred pain in the buttock thigh or leg was reported by 70% of subjects. The first aim was to compare the questionnaires for acceptability and comprehensibility. Data quality was high for all the questionnaires (less than 5% missing data). As expected, subjects found the more complex SF-36 Health Survey more difficult to complete than three of the low-back questionnaires. However, less than 10% of subjects found any of the questionnaires more than a little difficult to complete. The next aim was to explore the internal structure and inter-relationships of the low-back questionnaires and the three physical scales of the SF-36 Health Survey (Physical Functioning, Role-Physical and Bodily Pain). Analysis of item-item correlation, item-total correlation and Cronbach�s alpha confirmed that all scales were internally consistent. Factor analysis confirmed item homogeneity (unidimensionality) of all questionnaires except the Roland-Morris Disability Questionnaire. The questionnaires were significantly intercorrelated, but correlations exceeded .70 only for the Oswestry, Quebec and Waddell questionnaires. The next aim of the research was to compare test-retest reliability of the questionnaires. The Oswestry, Quebec and SF-36 Physical Functioning scale had sufficient reliability and scale width for clinical application. Despite previous reports of high reliability, the Roland-Morris scale was significantly less reliable than several of the other questionnaires. This indicates the importance of establishing the measurement properties of a test in the population or setting in which it will be used. The Waddell Disability Index, and the SF-36 Role-Physical and Bodily Pain scales had insufficient scale width to be useful in clinical practice. More than 15% of respondents had an initial score on these scales that would not allow change to be detected with 90% confidence. The next aim of the research was to compare the responsiveness of the questionnaires. None of the questionnaires was consistently identified as more or less responsive than the others although two methods (effect size and Liang�s standardized response mean) suggested the SF-36 Bodily Pain scale was more responsive than some other questionnaires. A secondary aim of this section was to evaluate the validity of the many available responsiveness indices and a novel �reliable change� method. A �known groups� strategy was used to determine whether the responsiveness index could discriminate between the low-back relevant questionnaires and the SF-36 General Health scale, the scores of which did not change across the retest period. With the exception of the novel �reliable change� method the responsiveness indices were all found to be valid indicators of responsiveness. Guyatt�s Responsiveness Index, effect size and Liang�s standardized response mean discriminated at 95% confidence between the reference scale and all the low-back questionnaires. The standardized response mean, t-test, correlation and ROC methods discriminated between the reference scale and five or six of the seven other questionnaires. Guyatt�s index was recommended as the best of the criterion-based methods, and the effect size the best of the distribution-based methods. The three questionnaires identified as having sufficient reliability and scale width, the Oswestry, Quebec and SF-36 Physical Functioning scale, were next analysed for data fit to a Rasch model. All three questionnaires had good data fit and item function was not affected by time, age, gender or whether or not subjects reported avoiding bending. The final aim of this research was to identify by Rasch analysis items to supplement the SF-36 Physical Functioning scale. The new scale, named the Low-Back SF-36 Physical Functioning18, showed comparable reliability and responsiveness to the SF-36 Physical Functioning scale. Further research is required to establish the measurement properties of the Low-Back SF-36 Physical Functioning18 scale in an independent sample. However, it has the potential to improve the clinical measurement of function by providing clinicians with a single measurement tool for comprehensive assessment of patients with low back pain.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Orientador: Rafael Zambelli de Almeida Pinto / Resumo: Investigar a capacidade dos diferentes domínios de atividade física, mensurados por meio de instrumentos objetivo e subjetivo, em predizer desfechos clínicos em pacientes com dor lombar crônica não específica. Materiais e métodos: O delineamento do estudo foi de coorte longitudinal com um seguimento de 6 meses. A amostra consistiu de 179 participantes com dor lombar crônica não específica. Na avaliação inicial, os seguintes dados foram coletados: dados antropométricos/ demográficos; duração e intensidade da dor (Escala Numérica de Dor); incapacidade funcional (Questionário de Incapacidade de Roland Morris); medo do movimento (Escala Tampa de Cinesiofobia); depressão (Inventário de Depressão de Beck) e nível de atividade física mensurado por meio do acelerômetro (período de tempo em atividades físicas leves e em atividade física moderada/vigorosa mensurados em minutos por dia, passos por dia e counts por minutos) e por meio do questionário de Atividade Física Habitual de Baecke (atividade física ocupacional, atividade física de lazer e locomoção e exercício físico). Após 6 meses os pacientes foram avaliados em relação a intensidade da dor e incapacidade funcional. Análise de regressão linear multivariada foi utilizada para investigar a associação dos domínios de atividade física com os desfechos clínicos de dor e incapacidade. Resultados: Um total de 179 participantes com dor lombar crônica não específica foram avaliados inicialmente, sendo que 150 participantes utilizaram o a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To investigate the ability of different physical activity domains, measured by objective and subjective instruments, in predicting clinical outcomes in chronic non-specific low back pain. Material and methods: Study design was a longitudinal cohort with 6 months follow-up. Sample size was of 179 participants with chronic non-specific low back pain. In the first evaluation, the following data were collected: anthropometric/demographic data; pain duration and intensity (Numerical Rating Scale); functional disability (Roland Morris Disability Questionnaire); fear of movement (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory) and physical activity levels measured by accelerometer (time spend in light, moderate/ vigorous physical activity, steps per day, Counts per minutes) and by Baecke questionnaire for the evaluation of habitual physical activity (occupational physical activities, leisure and locomotion physical activities and physical exercise). After 6 months patients were evaluated according to pain intensity and functional disability. Multivariate regression analysis was used to investigate the physical activity domains association with pain and disability outcomes. Results: A total of 179 participants with chronic non-specific low back pain were initially evaluated, of those, 150 participants wore accelerometer correctly in the initial evaluation. Results showed occupational physical activity, measured by Baecke questionnaire for the evaluation of habi... (Complete abstract click electronic access below) / Mestre

Bakgrund: Ryggproblematik är ett utbrett och vanligt förekommande problem som kostar samhället en stor summa pengar. Ett vanligt förekommande problemområde av ryggen är ländryggen. 70–80 % av Sveriges invånare drabbas någon gång under sin livstid av ländryggssmärta och många av dessa personer utvecklar kroniska besvär. En behandlingsform som används frekvent mot ländryggssmärta inom fysioterapin är bålträning. Det finns idag ingen vetenskaplig definition på bålträning och ingen rekommenderad standardiserad träning. Syfte: Undersöka bålträningens effekt på smärta och funktion jämfört med annan träning hos personer med ländryggssmärta. Metod: PubMed, Cinahl och SportDiscus var de tre databaserna som användes. Indexeringsorden ländryggsmärta och träning hämtades ifrån Svensk Mesh samt Cinahl Headings och sökorden blev; low back pain AND exercise/training AND core. Flera olika testsökningar genomfördes för att ta reda på de två ämnesområdenas (ländryggsmärta och bålträning) storlek, utbud och inriktningar. Artiklarna inkluderades efter titel, abstrakt och fulltext samt kvalitetsgranskades utifrån PEDro-scale. Sökproceduren sammanställdes i en tabell. Resultat: När bålträning jämfördes med annan träning kunde fem av elva studier visa på signifikanta förbättringar på smärta eller funktion. Totalt sett kunde majoriteten (9/11) av de inkluderade studierna visa på att bålträning är bra för att reducera smärta eller öka funktion hos personer som lider av ländryggssmärta. Konklusion: Resultatet av denna studie visar ett visst stöd för bålträningens effekt för att minska smärta och öka funktion hos ländryggspatienter. Bålträning verkar i många fall bättre än annan träning för att uppnå förbättringar.

A marcha humana, ou locomoção bípede, pode ser definida como sendo umprocesso contínuo de perda e recuperação o equilíbrio a partir da mudança de posição. Durante a marcha normal, a ativação da musculatura da coluna vertebral e acelerações do tronco resultam em ciclos de cargas aplicadas à coluna. O aumento da velocidade de caminhada aumenta a amplitude de movimento da coluna lombar e os níveis de ativação da musculatura ao redor do tronco. A coordenação postural automática alterada associada com lombalgia pode ser resultado de uma variedade de fatores que vão desde a estratégia de movimento escolhida até a diminuição da força exercida sobre a superfície de apoio, passando por mudanças nos níveis de contração muscular por medo do movimento e/ou dor. O foco atencional do indivíduo, quando dirigido a algum fator externo pode alterar a sua percepção da dor e diminuir as alterações em seus padrões de movimento na marcha. Estudos anteriores mostram que a força de reação do solo apresentou alterações significativas entre grupos de pessoas com e sem dor lombar crônica. O objetivo deste estudo foi analisar a possível influência do foco atencional no equilíbrio dinâmico de pessoas com dor lombar crônica bem como buscar, na marcha de pessoas com dor lombar crônica clinicamente comprovada, diferentes padrões de movimentos sob diferentes focos atencionais. Além disso, pretendeu-se descrever os efeitos dos diferentes focos atencionais sobre o comportamento das variáveis analisadas na marcha em sujeitos com e sem dor lombar crônica. Fizeram parte do grupo analisado 22 sujeitos que foram orientados, primeiramente, a executar três caminhadas que consistam em, ao menos, três ciclos completos da marcha na velocidade preferida, em linha reta, ao longo da pista de caminhada. Diferentes situações de condução do foco atencional foram utilizadas ao longo das caminhadas que se seguiram. A obtenção dos parâmetros cinemáticos angulares tridimensionais da marcha foi executada através de um sistema de análise de movimentos (Vicon Motion Systems) e os dados cinéticos foram obtidos utilizando-se duas plataformas de força modelo OR6-2000, (Advanced Mechanical Technology, Inc.,Watertown, MA, EUA). Todos os dados foram tabulados em planilhas eletrônicas do Microsoft Excel 2003 (Microsoft Corp., EUA). A análise estatística foi realizada no software SPSS 13.0, por meio de Análises de Variância entre as diferentes situações de condução do foco atencional e as variáveis analisadas, com nível de significância de 5%. A ANOVA entre as diferentes situações de condução do foco atencional e as variáveis analisadas não mostrou diferenças significativas entre cada tarefa executada simultaneamente à marcha dos indivíduos (p> 0,9). Conclui-se, a partir dos resultados encontrados, que as diferentes situações de condução do foco atencional utilizadas nesse estudo, apesar de referendadas pela bibliografia utilizada como base teórica, não podem ser usadas de maneira consistente como forma de diminuir os efeitos da dor lombar crônica sobre o comportamento das variáveis analisadas na marcha dos indivíduos avaliados nesse estudo. / The human gait, or bipedal locomotion, can be defined as the continuous process of losing and regaining balance from the change of a geographic location to another. During normal operation, the activation of the muscles of the spine and trunk accelerations result in load cycles applied to the column and increased walking speed increases the range of motion of the lumbar spine and the activation levels of the muscles around the trunk. Changes in the automatic postural coordination associated with low back pain may result from a variety of factors ranging from the motion strategy chosen to decrease the force exerted on the support surface , through changes in levels of muscular contraction for fear of movement and or pain. The attentional focus of the individual, when directed at some external factor, can change your perception of pain and decrease the changes in their patterns of gait movement. Previous studies show that the ground reaction force significantly changed between groups of people with and without chronic low back pain. The present study aimed to analyze the possible influence of attentional focus on dynamic balance of people with chronic low back pain and seek, in the gait of people with chronic low back pain clinically proven, different movement patterns under different attentional foci. In addition, we intend to describe the effects of different attentional focus on the behavior of the variables in gait in subjects with and without chronic low back pain. Formed the group examined 22 subjects who were asked, first, to run three walks consisting of at least three complete cycles of motion in preferred speed, straight along the hiking trail. Different leading situations of attentional focus were used along the walks that followed. The attainment of the three-dimensional angular kinematic parameters of gait was performed using a motion analysis system ( Vicon Motion Systems) and kinetic data were obtained using two force platforms model OR6 - 2000 ( Advanced Mechanical Technology , Inc. Watertown , MA , USA ) . All data were tabulated in spreadsheets Microsoft Excel 2003 ( Microsoft Corp . , USA ) . Statistical analysis was performed with SPSS 13.0, using analysis of variance between the different leading situations of the attentional focus and the other variables, with a significance level of 5 %. The ANOVA between different leading situations of the attentional focus and the other variables showed no significant differences between each task performed simultaneously with the motion of individuals (p > 0.9). It is concluded from the results that the different leading situations of the focus used in this study, although ratified by the bibliography used as a theoretical basis, can’t be used consistently in order to diminish the effects of chronic low back pain about the behavior of the variables in the gait of the subjects in this study.

A marcha humana, ou locomoção bípede, pode ser definida como sendo umprocesso contínuo de perda e recuperação o equilíbrio a partir da mudança de posição. Durante a marcha normal, a ativação da musculatura da coluna vertebral e acelerações do tronco resultam em ciclos de cargas aplicadas à coluna. O aumento da velocidade de caminhada aumenta a amplitude de movimento da coluna lombar e os níveis de ativação da musculatura ao redor do tronco. A coordenação postural automática alterada associada com lombalgia pode ser resultado de uma variedade de fatores que vão desde a estratégia de movimento escolhida até a diminuição da força exercida sobre a superfície de apoio, passando por mudanças nos níveis de contração muscular por medo do movimento e/ou dor. O foco atencional do indivíduo, quando dirigido a algum fator externo pode alterar a sua percepção da dor e diminuir as alterações em seus padrões de movimento na marcha. Estudos anteriores mostram que a força de reação do solo apresentou alterações significativas entre grupos de pessoas com e sem dor lombar crônica. O objetivo deste estudo foi analisar a possível influência do foco atencional no equilíbrio dinâmico de pessoas com dor lombar crônica bem como buscar, na marcha de pessoas com dor lombar crônica clinicamente comprovada, diferentes padrões de movimentos sob diferentes focos atencionais. Além disso, pretendeu-se descrever os efeitos dos diferentes focos atencionais sobre o comportamento das variáveis analisadas na marcha em sujeitos com e sem dor lombar crônica. Fizeram parte do grupo analisado 22 sujeitos que foram orientados, primeiramente, a executar três caminhadas que consistam em, ao menos, três ciclos completos da marcha na velocidade preferida, em linha reta, ao longo da pista de caminhada. Diferentes situações de condução do foco atencional foram utilizadas ao longo das caminhadas que se seguiram. A obtenção dos parâmetros cinemáticos angulares tridimensionais da marcha foi executada através de um sistema de análise de movimentos (Vicon Motion Systems) e os dados cinéticos foram obtidos utilizando-se duas plataformas de força modelo OR6-2000, (Advanced Mechanical Technology, Inc.,Watertown, MA, EUA). Todos os dados foram tabulados em planilhas eletrônicas do Microsoft Excel 2003 (Microsoft Corp., EUA). A análise estatística foi realizada no software SPSS 13.0, por meio de Análises de Variância entre as diferentes situações de condução do foco atencional e as variáveis analisadas, com nível de significância de 5%. A ANOVA entre as diferentes situações de condução do foco atencional e as variáveis analisadas não mostrou diferenças significativas entre cada tarefa executada simultaneamente à marcha dos indivíduos (p> 0,9). Conclui-se, a partir dos resultados encontrados, que as diferentes situações de condução do foco atencional utilizadas nesse estudo, apesar de referendadas pela bibliografia utilizada como base teórica, não podem ser usadas de maneira consistente como forma de diminuir os efeitos da dor lombar crônica sobre o comportamento das variáveis analisadas na marcha dos indivíduos avaliados nesse estudo. / The human gait, or bipedal locomotion, can be defined as the continuous process of losing and regaining balance from the change of a geographic location to another. During normal operation, the activation of the muscles of the spine and trunk accelerations result in load cycles applied to the column and increased walking speed increases the range of motion of the lumbar spine and the activation levels of the muscles around the trunk. Changes in the automatic postural coordination associated with low back pain may result from a variety of factors ranging from the motion strategy chosen to decrease the force exerted on the support surface , through changes in levels of muscular contraction for fear of movement and or pain. The attentional focus of the individual, when directed at some external factor, can change your perception of pain and decrease the changes in their patterns of gait movement. Previous studies show that the ground reaction force significantly changed between groups of people with and without chronic low back pain. The present study aimed to analyze the possible influence of attentional focus on dynamic balance of people with chronic low back pain and seek, in the gait of people with chronic low back pain clinically proven, different movement patterns under different attentional foci. In addition, we intend to describe the effects of different attentional focus on the behavior of the variables in gait in subjects with and without chronic low back pain. Formed the group examined 22 subjects who were asked, first, to run three walks consisting of at least three complete cycles of motion in preferred speed, straight along the hiking trail. Different leading situations of attentional focus were used along the walks that followed. The attainment of the three-dimensional angular kinematic parameters of gait was performed using a motion analysis system ( Vicon Motion Systems) and kinetic data were obtained using two force platforms model OR6 - 2000 ( Advanced Mechanical Technology , Inc. Watertown , MA , USA ) . All data were tabulated in spreadsheets Microsoft Excel 2003 ( Microsoft Corp . , USA ) . Statistical analysis was performed with SPSS 13.0, using analysis of variance between the different leading situations of the attentional focus and the other variables, with a significance level of 5 %. The ANOVA between different leading situations of the attentional focus and the other variables showed no significant differences between each task performed simultaneously with the motion of individuals (p > 0.9). It is concluded from the results that the different leading situations of the focus used in this study, although ratified by the bibliography used as a theoretical basis, can’t be used consistently in order to diminish the effects of chronic low back pain about the behavior of the variables in the gait of the subjects in this study.

A marcha humana, ou locomoção bípede, pode ser definida como sendo umprocesso contínuo de perda e recuperação o equilíbrio a partir da mudança de posição. Durante a marcha normal, a ativação da musculatura da coluna vertebral e acelerações do tronco resultam em ciclos de cargas aplicadas à coluna. O aumento da velocidade de caminhada aumenta a amplitude de movimento da coluna lombar e os níveis de ativação da musculatura ao redor do tronco. A coordenação postural automática alterada associada com lombalgia pode ser resultado de uma variedade de fatores que vão desde a estratégia de movimento escolhida até a diminuição da força exercida sobre a superfície de apoio, passando por mudanças nos níveis de contração muscular por medo do movimento e/ou dor. O foco atencional do indivíduo, quando dirigido a algum fator externo pode alterar a sua percepção da dor e diminuir as alterações em seus padrões de movimento na marcha. Estudos anteriores mostram que a força de reação do solo apresentou alterações significativas entre grupos de pessoas com e sem dor lombar crônica. O objetivo deste estudo foi analisar a possível influência do foco atencional no equilíbrio dinâmico de pessoas com dor lombar crônica bem como buscar, na marcha de pessoas com dor lombar crônica clinicamente comprovada, diferentes padrões de movimentos sob diferentes focos atencionais. Além disso, pretendeu-se descrever os efeitos dos diferentes focos atencionais sobre o comportamento das variáveis analisadas na marcha em sujeitos com e sem dor lombar crônica. Fizeram parte do grupo analisado 22 sujeitos que foram orientados, primeiramente, a executar três caminhadas que consistam em, ao menos, três ciclos completos da marcha na velocidade preferida, em linha reta, ao longo da pista de caminhada. Diferentes situações de condução do foco atencional foram utilizadas ao longo das caminhadas que se seguiram. A obtenção dos parâmetros cinemáticos angulares tridimensionais da marcha foi executada através de um sistema de análise de movimentos (Vicon Motion Systems) e os dados cinéticos foram obtidos utilizando-se duas plataformas de força modelo OR6-2000, (Advanced Mechanical Technology, Inc.,Watertown, MA, EUA). Todos os dados foram tabulados em planilhas eletrônicas do Microsoft Excel 2003 (Microsoft Corp., EUA). A análise estatística foi realizada no software SPSS 13.0, por meio de Análises de Variância entre as diferentes situações de condução do foco atencional e as variáveis analisadas, com nível de significância de 5%. A ANOVA entre as diferentes situações de condução do foco atencional e as variáveis analisadas não mostrou diferenças significativas entre cada tarefa executada simultaneamente à marcha dos indivíduos (p> 0,9). Conclui-se, a partir dos resultados encontrados, que as diferentes situações de condução do foco atencional utilizadas nesse estudo, apesar de referendadas pela bibliografia utilizada como base teórica, não podem ser usadas de maneira consistente como forma de diminuir os efeitos da dor lombar crônica sobre o comportamento das variáveis analisadas na marcha dos indivíduos avaliados nesse estudo. / The human gait, or bipedal locomotion, can be defined as the continuous process of losing and regaining balance from the change of a geographic location to another. During normal operation, the activation of the muscles of the spine and trunk accelerations result in load cycles applied to the column and increased walking speed increases the range of motion of the lumbar spine and the activation levels of the muscles around the trunk. Changes in the automatic postural coordination associated with low back pain may result from a variety of factors ranging from the motion strategy chosen to decrease the force exerted on the support surface , through changes in levels of muscular contraction for fear of movement and or pain. The attentional focus of the individual, when directed at some external factor, can change your perception of pain and decrease the changes in their patterns of gait movement. Previous studies show that the ground reaction force significantly changed between groups of people with and without chronic low back pain. The present study aimed to analyze the possible influence of attentional focus on dynamic balance of people with chronic low back pain and seek, in the gait of people with chronic low back pain clinically proven, different movement patterns under different attentional foci. In addition, we intend to describe the effects of different attentional focus on the behavior of the variables in gait in subjects with and without chronic low back pain. Formed the group examined 22 subjects who were asked, first, to run three walks consisting of at least three complete cycles of motion in preferred speed, straight along the hiking trail. Different leading situations of attentional focus were used along the walks that followed. The attainment of the three-dimensional angular kinematic parameters of gait was performed using a motion analysis system ( Vicon Motion Systems) and kinetic data were obtained using two force platforms model OR6 - 2000 ( Advanced Mechanical Technology , Inc. Watertown , MA , USA ) . All data were tabulated in spreadsheets Microsoft Excel 2003 ( Microsoft Corp . , USA ) . Statistical analysis was performed with SPSS 13.0, using analysis of variance between the different leading situations of the attentional focus and the other variables, with a significance level of 5 %. The ANOVA between different leading situations of the attentional focus and the other variables showed no significant differences between each task performed simultaneously with the motion of individuals (p > 0.9). It is concluded from the results that the different leading situations of the focus used in this study, although ratified by the bibliography used as a theoretical basis, can’t be used consistently in order to diminish the effects of chronic low back pain about the behavior of the variables in the gait of the subjects in this study.

Orientador: Paulo Henrique Ferreira Caria / Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-15T20:49:44Z (GMT). No. of bitstreams: 1 Rocha_CamilaPinhata_M.pdf: 1973826 bytes, checksum: addb18854a50f7ddac32a6484cdaf31b (MD5) Previous issue date: 2010 / Resumo: Diferentes modalidades de tratamento vêm sendo utilizados por fisioterapeutas com a intenção de reverter quadros de disfunção da coluna vertebral, inclusive da região lombar, com intuito de reduzir a sintomatologia. Assim, realizou-se uma revisão da literatura com o objetivo de verificar os efeitos dos tratamentos fisioterapêuticos utilizados no tratamento da dor lombar. O levantamento bibliográfico, de janeiro de 2005 a outubro de 2009, foi feito nas seguintes bases de dados ISI, Pubmed, Bireme e Cochrane. Dois pesquisadores realizaram a busca individualmente, com as palavras chave physical therapy, physiotherapy, rehabilitation e low back pain e selecionaram os artigos relacionados aos recursos e métodos fisioterapêuticos relevantes no tratamento da lombalgia crônica não específica, sendo esses, estudos clínicos. Foram encontrados 22 artigos e selecionados 15, os quais atenderam aos critérios de inclusão desta pesquisa. Os resultados demonstraram que os diferentes métodos de tratamento utilizados pelos fisioterapeutas proporcionam efeitos positivos aos pacientes portadores de lombalgia crônica não específica, no entanto algumas inconsistências foram observadas no que diz respeito ao limiar de dor, pois não se encontraram trabalhos que dessem atenção ao gênero e ao ciclo menstrual, variáveis relevantes no estudo da dor. Esta revisão serviu para subsidiar pesquisas futuras nessa área, beneficiando a população. Além da revisão dois outros estudos experimentais foram realizados, com o objetivo de verificar o efeito do método Pilates e da eletroestimulação neuromuscular (EENM) em mulheres com idade entre 25 a 45 anos, índice de massa corpórea entre 18,5 e 24 Kg/cm2, com história de lombalgia crônica não específica, confirmado pelo Quebec Back Pain Disability Scale (QBPDS). As mulheres eram sedentárias e não deveriam ter recebido intervenção física para lombalgia no último mês antes do estudo. Aquelas que fizessem uso de medicação analgésica foram excluídas. Avaliou-se (1) Escore de Funcionalidade pelo Oswestry Disability Questionnaire (OSD); (2) Intensidade da dor, pela escala visual analógica (EVA); (3) Alinhamento postural pela fotogrametria e (4) Perimetria pela mensuração das circunferências abdominais (cintura e cicatriz onfálica) para o grupo tratado com EENM. Os tratamentos foram constituídos de três sessões semanais, realizadas durante 5 semanas, totalizando 15 sessões. No primeiro estudo, 18 voluntárias com idade média de 32,25±7,75 anos, índice de massa corpórea média de 22,42±1,60 Kg/cm2 receberam o método Pilates como tratamento. Neste grupo os resultados da intensidade da dor obtidos pela EVA foram de 2,82, 1,41 e 0,41 para as sessões 1, 7 e 15, respectivamente, sendo estatisticamente significativas para as sessões 7 e 15 em relação à sessão 1. Os escores dado pelo OSD foram de 28,36, 17,12 e 7,86 para as mesmas sessões da intensidade da dor, com diferenças significativas entre as sessões 1 e 15. Não foi observada diferença significativa nas varáveis da fotogrametria (p=0,9442). No segundo estudo, referente ao tratamento feito com EENM, 19 mulheres com idade média de 36,36±7,30 anos, índice de massa corpórea média de 23,01±1,73 Kg/cm2, foram avaliadas. Os resultados do OSD foram significativamente menores na sessão 15 (7,00) em relação às sessões 1 (19,33) e 7 (11,31). Houve diminuição significativa da intensidade da dor dada pela EVA nas sessões 7 (0,92) e 15 (0,76) em relação à sessão 1 (2,76). Na fotogrametria também foi observada diferença significativa após o tratamento (p<0,0355), indicando melhora no alinhamento corporal. Não foi observada diferença estatisticamente significativa nas medidas das circunferências abdominais. De acordo com os resultados apresentados pelas amostras avaliadas, pode-se concluir que ambos os procedimentos, método Pilates e EENM, foram eficazes no tratamento da dor lombar crônica não específica / Abstract: Treatment modalities have been used by physical therapists with the aim to revert spine dysfunction, including lumbar region, in order to reduce symptoms. A literature review was carried out to verify effects of physiotherapy treatments used in low back pain treatment. The search was made from January 2005 to October 2009, in ISI, Pubmed, Bireme and Cochrane. Two individually researchers conducted the search and selected the relevant articles using the key-words physical therapy, physiotherapy, rehabilitation and low back pain. It was found 22 articles and 15 were selected, according to the inclusion criteria. The results showed that the different treatment methods used by physiotherapists provided positive effects for patients with nonspecific low back pain. However, some inconsistencies were observed in the results of those studies, because gender and the menstrual cycle have not been taken into account for studying pain threshold. This review was important to identify, review and evaluate previous studies about the physiotherapy treatment for nonspecific chronic low back pain and to guide further research in this area, to benefit the population. In this way, two studies were performed with objective to investigate the effects of Pilates method and electrical neuromuscular (NMES) in women aged 25 to 45 years, with nonspecific chronic low back pain, confirmed by Quebec Back Pain Disability Scale (QBPDS). The women were sedentary, presenting body mass index between 18,5 and 24 Kg/cm2 and should not have received physical intervention for low back pain in the last month before the study. Those who made use of analgesic medication were excluded. The following parameter were evaluated (1) score functionality using the Oswestry Disability Questionnaire (OSD), (2) intensity of pain by visual analogical scale (VAS) (3) postural alignment by photogrammetry and (4) Perimetry, measuring the waistcircumferences, for the group treated with NMES. The treatments consisted of three weekly sessions, held for 5 weeks, totaling 15 sessions. In the first study, 18 volunteers with a mean age of 32.25 ± 7.75 years, mean body mass index average of 22.42 ± 1.60 Kg/cm2 received the Pilates method as a treatment. In this group, the results of the intensity of pain obtained by VAS were 2.82, 1.41 and 0.41 for sessions 1, 7 and 15, respectively, being significant statistically for Sessions 7 and 15 in relation the session 1. The scores given by the OSD were 28.36, 17.12 and 7.86 for the same sessions of the intensity of pain, with significant differences between sessions 1 and 15. There was no significant difference in the variables of photogrammetry (p=0.9442). In the second study with the processing done by NMES, 19 women with a mean age of 36.36±7.30 years, mean body mass index of 23.01 ± 1.73 Kg/cm2 were evaluated. The results of functional scores in session 15 (7.00) were significantly lower than sessions 1 (19.33) and 7 (11.31). Significant decrease in pain intensity (VAS) occurred in sessions 7 (0.92) and 15 (0.76) compared to session 1 (2.76). In photogrammetry, there was significant difference after treatment (p <0.0355), indicating an improvement in body alignment. There was no significant statistically difference in measures of waist circumference. In accordance with the results presented by the studied samples, it can be concluded that both treatments, Pilates and NMES, were effective for relief of nonspecific chronic low back pain / Mestrado / Anatomia / Mestre em Biologia Buco-Dental